Forms

Download Forms

Before your initial visit, please take a few minutes to download, print, and complete the forms provided below.  Bring them with you to your appointment.   This will allow us to use our time together to focus on you and your goals.  If you do decide to complete the forms at the office, please allow some extra minutes before your appointment to do so. This will allow us to better use out time together.

NB. These forms are in PDF format. You will need Adobe Reader to view these files. If you do not have Adobe Reader installed, you can download it by clicking here.

 

Patient Registration Form – Please complete the form before arriving for your initial evaluation.

 

Patient Questionnaire I – Symptoms and Concerns – This will provide clinical information which will greatly assist me in making an accurate assessment of you Whole Person needs.

 

Personal Information Questionnaire – This form will provide me with background about certain past and present aspects of your personal and family circumstances which will help decide your treatment for “Whole Person growth”

 

Couples Questionnaire – This is intended for couples coming for marital counselling. It is to be completed by each member of the couple. Take your time and fill it out as best as you can. This form was Developed by Dr. John. W. Wilson. http://wilson-psychological.com/home

 

 Informed consent – This form outlines some my services, policies and procedures. I am required to have your informed consent in order to provide you with the best possible treatment.  Please review the terms listed in the document, sign, and bring with you to your first appointment.

 

Release of Information – I am a strong believer that collaboration between health care providers is key to providing effective care to our clients.  If you are currently seeing another therapist, primary care physician or other health care professional, and would like us to coordinate care, or you would like me to have records from a previous psychiatrist or hospitalization to aid in forming your treatment plan, please fill out this form.  Print and sign one form for each individual or facility to/from whom you would like me to release/obtain medical information.